Fraser Health has launched a public awareness campaign encouraging pregnant people and people with syphilis symptoms to get tested for the sexually transmitted infection as cases continue to climb in British Columbia.
In 2019 the provincial health officer declared a syphilis outbreak in B.C. based on rising case numbers.
Since then the entire province has seen a “dramatic” increase in cases, said Dr. Vincent Valdrez, a BC Centre for Disease Control sexually transmitted infection physician.
During the first six months of this year, B.C. had 1,049 cases of infectious syphilis, up from 154 cases in all of 2010. There were 1,060 cases in 2019, and 1,964 in 2022, according to the 2023 BC Syphilis Action Plan Refresh.
A decade ago most syphilis cases were among men who have sex with men, but today two-thirds of syphilis cases occur in people who report having only heterosexual partners, and one-third of all cases are in women, he said.
To boost public awareness about syphilis and the importance of testing, Fraser Health has placed ads on buses and bus stops. They’ve also placed digital ads in Fraser Health facilities, online and on Facebook and Instagram, the health authority told The Tyee in an email.
Valdrez said it’s not clear why case counts are increasing and the demographics are significantly shifting, but it’s important that people know that anyone who is sexually active has some risk of contracting an STI.
Testing is recommended for anyone who has never been tested, has a sexual partner who tested positive, is pregnant or has a new sexual partner, and, of course, anyone who is symptomatic. Regular testing at least every few months is recommended for anyone who has multiple sexual partners or engages in other activities that can increase the risk of exposure, such as sex work.
Syphilis is a bacterial infection that is usually transmitted through sexual contact, often through a lesion like a genital ulcer, but also can be transmitted when the infected person is asymptomatic, Valdrez said. A pregnant person can also transmit the infection to their developing fetus.
The first stage usually consists of a painless sore or sores on the genitals, lips, mouth or anus. The infection then spreads to the rest of the body. At the second stage, symptoms can include a non-itchy rash on the chest, belly, genitals, palms or soles of the feet, having a headache, fever, hair loss or swollen lymph nodes, and having bumps or patches inside the mouth, anus and genitals, according to the SmartSexResource, a service provided by the BC Centre for Disease Control.
Syphilis is called the “great mimicker” because these symptoms are non-specific and can be mistaken for other conditions, Valdrez said. It’s important for individuals but also clinicians to be aware of the symptoms and to include syphilis testing when trying to diagnose an illness.
The third stage is called the “dormant” or “latent” phase, Valdrez said. It doesn’t have symptoms but can still be contagious.
Within as little as a year after infection, syphilis can spread to different organ systems, such as the nervous system, he said. An infection can make people “go blind, [or] people can lose their hearing and it can spread to the brain and people can get strokes or seizures,” which are caused by inflammation around the brain, Valdrez said.
“It’s very important to catch syphilis early and to treat it early to prevent these longer-term effects,” Valdrez said.
Congenital syphilis
An increase in infections in people assigned female at birth is doubly concerning because of the risk of congenital syphilis, in which a pregnant person can transmit the infection to a developing fetus, Valdrez said.
Congenital syphilis can mean “babies are quite sick when they’re born, and it can lead to long-term health effects, in their immediate future but also later in life,” he added.
Congenital syphilis can result in premature birth, low birthweight and other serious debilitating conditions, including stillbirth, according to Fraser Health.
In 2022, over 90 per cent of women with infectious syphilis were between the ages of 15 and 49, according to the 2023 BC Syphilis Action Plan Refresh.
There were 355 cases of infectious syphilis in females aged 15 to 49 during the first half of this year, according to the BC Centre for Disease Control. Twenty-three of those cases were diagnosed during prenatal screening.
There were 21 cases of congenital syphilis in 2023, up from two cases in 2020, Fraser Health said.
In 2019 B.C. introduced a new guideline for pregnant people to test for syphilis during the first trimester or at the first prenatal visit, and again during delivery.
Valdrez said a syphilis blood test ideally happens during the first trimester so there are at least four weeks between when they get treatment and when they deliver. This “would ensure a treatment of the syphilis infection in both the pregnant person and the prevention of transmission to the baby,” he said.
Unfortunately people aren’t always interacting with the health-care system during their first trimester of pregnancy, he said. There are complex reasons why people don’t access medical care at regular intervals, he added. For example, a person may be unhoused and learn they are pregnant and have syphilis only when they seek emergency care for an unrelated issue, he said.
Late is better than never, he said.
The good news: syphilis is curable
The good news is that testing and treatment for STIs is free in B.C., and that syphilis can be cured with antibiotics at any stage of the infection. Further good news is that, so far, there haven’t been any antibiotic-resistant cases of syphilis found in the province, Valdrez said.
British Columbians can speak with their doctor about getting tested for STIs, or use other free and confidential testing services like the BC Centre for Disease Control’s GetCheckedOnline.
GetCheckedOnline allows people to make a lab form that they can take to participating labs for free STI testing. Participants don’t need to provide their name or have a Medical Services Plan number — you just need to provide an email and phone number. There are participating labs in Vancouver, Maple Ridge, Victoria, Duncan, Kamloops, Kimberley and Nelson.
Vancouver is also home to the BC Centre for Disease Control’s STI clinic, located near City Hall and open six days a week. The STI clinic offers free and confidential testing and treatment, and patients are not required to be enrolled in B.C.’s provincial health care.
Options for Sexual Health has 60 clinics across the province that provide free STI testing and treatment for people enrolled in MSP. Those without MSP coverage may be charged up to $200, depending on the service, and Options for Sexual Health does not offer anonymous testing like GetCheckedOnline or the BC Centre for Disease Control STI clinic.
Syphilis can be treated for free in B.C. with penicillin injections. Urgent and primary care centres, emergency departments, sexual health clinics, community health centres and public health centres will generally have these stocked, or a doctor could order and administer the treatment regardless of where you live in B.C., Valdrez said. Alternative antibiotics are available for people with penicillin allergies; people should discuss options with the doctor who is treating them.
Men who have sex with men and are at high risk of contracting STIs should speak with their doctor about other preventive measures they could take, Valdrez added.
